Adrim Drug Interactions

Effect of CYP3A4 Inhibitors, Inducers and P-gp: Doxorubicin is a major substrate of cytochrome P450 CYP3A4 and CYP2D6, and P- glycoprotein (P-gp). Clinically significant interactions have been reported with inhibitors of CYP3A4, CYP2D6, and/or P-gp (e.g., verapamil), resulting in increased concentration and clinical effect of doxorubicin. Inducers of CYP3A4 (e.g., phenobarbital, phenytoin, St. John's Wort) and P-gp inducers may decrease the concentration of doxorubicin. Avoid concurrent use of doxorubicin hydrochloride with inhibitors and inducers of CYP3A4, CYP2D6, or P-gp.
Trastuzumab: Concurrent use of trastuzumab and doxorubicin hydrochloride results in an increased risk of cardiac dysfunction. Avoid concurrent administration of doxorubicin and trastuzumab. The appropriate interval for administering doxorubicin following trastuzumab therapy has not been determined.
Paclitaxel: Paclitaxel, when given prior to doxorubicin hydrochloride, increases the plasma- concentrations of doxorubicin and its metabolites. Administer doxorubicin hydrochloride prior to paclitaxel if used concomitantly.
Dexrazoxane: Do not administer dexrazoxane as a cardioprotectant at the initiation of doxorubicin hydrochloride containing chemotherapy regimens. Dexrazoxane may diminish the therapeutic effect of Doxorubicin. This recommendation does not apply to the use of dexrazoxane for other indications (e.g., extravasation), or to the use of dexrazoxane later in treatment.
Mercaptopurine: Doxorubicin may enhance the hepatotoxicity of mercaptopurine.